Is 30-Day Mortality a Better Predictor of HF Survival Than Hospital Readmission Rate?


A recent study investigated whether risk-standardized mortality rate (RSMR) is an effective predictor of long-term survival in hospitalized patients with heart failure.

For patients who are hospitalized with heart failure, the long-term impact of hospitalization based on 30-day RSMRs is relatively unknown.

Gregg C Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center (Los Angeles, CA), and associated editor, Health Care Quality and Guidelines, JAMA Cardiology, and colleagues conducted a longitudinal observational study to evaluate the association of hospital-specific 30-day RSMR with long-term survival among 106,304 patients hospitalized with heart failure in the American Heart Association Get With the Guidelines-Heart Failure registry. Participants were admitted to 317 centers from 2005 through 2013 and had Medicare-linked follow-up data.

Hospital-specific 30-day RSMR was calculated using a hierarchical logistic regression model, which had 30-day mortality rate as a binary outcome, patient baseline characteristics as covariates, and hospitals as random effects. The association between 30-day RSMR-based hospital groups and long-term mortality was evaluated using adjusted Cox models.

Long-term mortality was measured through one-year, 3-year, and 5-year mortality rates. The 30-day RSMR-based hospital groups were designated by low (quartile 1 [Q1]) to high (Q4) 30-day RSMR.

The study was published in JAMA Cardiology (online March 12, 2018; doi:10.1001/jamacardio.2018.0579).

Results of the study showed the median 30-day RSMR was 9.7% overall – 8.64% for Q1 based on RSMR and 10.75% for Q4. Researchers noted that Q1 hospitals were more likely to be large, based in urban areas, and offer more advanced heart failure treatments.


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Additionally, researchers reported that survival at one-year, 3-years, and 5-years was superior for patients treated at the Q1 hospitals compared with patients at the Q4 hospitals. Five-year mortality was 73.1% for Q1 compared with 76.8% for Q4, with an adjusted relative hazard of mortality of 1.14 for high versus low RSMR hospitals.

Dr Fonarow and colleagues acknowledged that these differences in 30-day survival continued to accrue beyond 30 days and persisted long term. The concluded that “30-day RSMR may be a useful heart failure performance metric to incentivize quality care and improve long-term outcomes.”—Zachary Bessette